Notice: This CMS-approved document has been submitted - Philips ...

CMS-1403-FC
safeguards we could include in an exception if we were to
do so (for example, reduced payments for maintenance of
patient care quality compared with payments for the
achievement of targets); and [32] whether the answer to
[33] differs for incentive payment programs as opposed to
shared savings programs.
We have had limited opportunity to review incentive
payment and shared programs for compliance with the
physician self-referral law, and we lack familiarity with
the specifics of measuring achievements and calculating
payments under such programs. We received insufficient
information in the public comments to set forth with enough
specificity conditions regarding the calculation of cost
savings so as to enable parties to evaluate compliance with
the exception. We proposed to require that payments that
result from cost savings be calculated based on acquisition
costs for the items at issue, as well as the costs involved
in providing the specified services, and that they be
calculated on the basis of all patients, regardless of
insurance coverage (73 FR 38556). Many commenters stated
that the term “acquisition costs” was unclear or that it is
difficult to determine the actual costs involved in
providing specified services, and suggested that we provide
additional guidance regarding these concepts if we were to
406